HomeMy WebLinkAboutFolk 963 Nettles Blvd_permit submittalAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
(54
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Residential x
Address: 963 Nettles Blvd Apt 1306 Jensen Beach FL 34957
Property Tax ID #: 4502-501-1150-000-4 Lot No.
Site Plan Name: Block No.
Project Name: Folk - 963 Nettles Blvd
OWNERAESSEE: I CONTRACTOR:
Name Donald G Folk. Ann Marie Folk
Name: Douglas E. Roe
Address: 963 Nettles Blvd Apt 1306
Company: Code Red Roofers, Inc
City: Jensen Beach State: _
Zip Code: 34957 Fax:
Phone No. 678-362-8526
Address: 3341 SE Slater St
City: Stuart State: FL
Zip Code: 34997 Fax:
Phone No 772-287-2829
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Permits@coderedroofers.com
State or County License CCC1325674
IT value or construction is ZSUU or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
UCTION LIEN LAW INFORMATION:
IGNER/ENGINEER: _ Not Applicable
e:
7Address:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
Z" ` 11L
�/� / / `—_
Signature of Contractor/License Holder
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF �.�1�
Sworn to (or affirmed) and subscribed before me of
Physical Pre ence or Online Notarization
this day of -'. ,z 2020 by
Sworn to (or affirmed) and subscribed before me of
X Physical Presence or Online Notarization
this day of A",Cg2020 by
Name of person making statement.
Name of person making statement.
Personally Known X OR Produced Identification
Personally Known � OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Signat a of Notar ublic State of Florida
nat a of Not Public State of Florida )
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EXPIRES October 03. 20
2
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Rev. 516120